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Hepatitis C: Treatments

Infectious liver disease caused by the hepatitis C virus for which there is no vaccine and which commonly becomes chronic. Now the most common cause of cirrhosis in the United States.

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(Source: NIH - National Institute of Diabetes and Digestive and Kidney Diseases and National Library of Medicine)

About Treatments for Hepatitis C

Depending on the amount of damage to your liver, your medical history, and your preferences, you and your doctor may decide on one of the following treatment plans:

  • Treatment right away. If your liver has a lot of damage, your doctor may suggest you have treatment right away.
  • Waiting and followup. If your liver does not have a lot of damage and you do not need treatment right away, your doctor may suggest you wait. Some people wait years before starting treatment. If you decide to wait, your doctor will probably want to check your liver on a regular basis to see if and possibly when you might need treatment.

Before deciding how to treat your chronic hepatitis C infection, some doctors may first suggest a liver biopsy. During a liver biopsy, the doctor removes a tiny piece of your liver to look for signs of damage or disease. The results of the biopsy help the doctor decide if you need treatment... Read more about Hepatitis C: Treatments

What works? Research summarized

Evidence reviews

Antiviral therapy for recurrent liver graft infection with hepatitis C virus

The liver is an important organ of the body and has various functions including generation of energy from food; production of material necessary for congealing, processing, and excretion of drugs and waste products in blood; and filtering out the harmful bacteria that enter the body through the gut. Hepatitis C virus can cause damage to the liver usually in an insidious manner (chronic hepatitis C infection). Sometimes, the liver damage can be so severe that the liver is not able to carry out the normal functions, resulting in liver failure. Liver transplantation is an effective treatment for the treatment of liver failure due to chronic hepatitis C infection. However, liver transplantation does not eradicate the virus and the virus can affect the donor liver graft. One of the proposed strategies to treat the recurrence of chronic hepatitis C virus infection in these patients is using antiviral treatments. The effectiveness of these treatments is not known. We performed a detailed review of the medical literature (to February 2013) to determine the benefits and harms of different antiviral treatments for patients with recurrent hepatitis C infection after undergoing liver transplantation for chronic hepatitis C virus infection. We sought evidence from randomised clinical trials only. When conducted properly, such trials provide the best evidence. Two authors independently identified the trials and obtained the information from the trials to minimise error.

Antiviral therapy to prevent the recurrence of chronic hepatitis C infection in patients undergoing liver transplantation

The liver is an important organ of the body and has various functions including generation of energy from food, production of material necessary for congealing, processing and excretion of drugs and waste products in blood, and filtering out the harmful bacteria that enter the body through the gut. Hepatitis C virus can cause damage to the liver usually in an insidious manner (chronic hepatitis C virus infection). Sometimes, the liver damage can be so severe that the liver is not able to carry out the normal functions, which results in liver failure. Liver transplantation is effective in treating liver failure due to chronic hepatitis C infection. However, liver transplantation does not eradicate the virus and the virus can affect the donor liver graft. One of the proposed strategies to prevent the recurrence of chronic hepatitis C infection in these patients is to give drug treatment before the donor liver graft is affected by chronic hepatitis C infection. The effectiveness of these preventive treatments is not known. The review authors performed a detailed review of the medical literature to February 2013 to determine the benefits and harms of different preventive antiviral treatments for patients undergoing liver transplantation for chronic hepatitis C virus infection. The review authors sought evidence from randomised clinical trials only. When conducted properly, such trials provide the best evidence. Two review authors independently identified the trials and obtained the information from the trials to minimise error.

Antiviral treatment for chronic hepatitis C in patients with HIV infection

End‐stage liver disease due to chronic hepatitis C is the leading cause of death among patients with stable HIV. The recommended treatment for chronic hepatitis C among patients without HIV is peginterferon plus ribavirin. Based on evidence from trials on HIV‐negative patients with hepatitis C, the viral genotype, dose of treatment and duration of therapy may affect the treatment response. This review is the first to evaluate the antiviral effect of peginterferon, ribavirin or amantadine administered in different combinations for a patient group, which has not previously been treated for hepatitis C. A total of 14 randomised clinical trials with at total of 2269 patients have been included in this review.The present review suggests that peginterferon plus ribavirin may also be considered if patients have HIV. The dose of peginterferon was similar to that assessed in trials on patients without HIV (180 microgram or 1.5 microgram/kg once weekly), but the dose of ribavirin was somewhat lower in most trials (800 mg daily). There were considerable differences between the trials possibly related to the dose and duration of treatment or the proportion of patients with different hepatitis C virus genotypes. The benefit of treatment was seen when assessing the proportion of patients with a sustained loss of the hepatitis C virus from the blood and the proportion with improved liver biopsies. No significant differences were seen in clinical outcome measures, including mortality (1%, irrespective of treatment). There were several adverse events. Fatal lactic acidosis and liver failure occurred. Other adverse events included anaemia and flu‐like symptoms that occurred more frequently among patients receiving peginterferon plus ribavirin. No significant differences were seen regarding the risk of depression, mortality, and progression to cirrhosis or to AIDS. Additional randomised trials are necessary to assess the effect in HIV and HCV co‐infected patients of peginterferon plus ribavirin in relation to the duration of therapy, especially in patients with hepatitis C genotype 2 or 3. Additional trials comparing peginterferon plus ribavirin versus interferon plus ribavirin or peginterferon alone do not seem warranted.

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Summaries for consumers

Antiviral therapy for recurrent liver graft infection with hepatitis C virus

The liver is an important organ of the body and has various functions including generation of energy from food; production of material necessary for congealing, processing, and excretion of drugs and waste products in blood; and filtering out the harmful bacteria that enter the body through the gut. Hepatitis C virus can cause damage to the liver usually in an insidious manner (chronic hepatitis C infection). Sometimes, the liver damage can be so severe that the liver is not able to carry out the normal functions, resulting in liver failure. Liver transplantation is an effective treatment for the treatment of liver failure due to chronic hepatitis C infection. However, liver transplantation does not eradicate the virus and the virus can affect the donor liver graft. One of the proposed strategies to treat the recurrence of chronic hepatitis C virus infection in these patients is using antiviral treatments. The effectiveness of these treatments is not known. We performed a detailed review of the medical literature (to February 2013) to determine the benefits and harms of different antiviral treatments for patients with recurrent hepatitis C infection after undergoing liver transplantation for chronic hepatitis C virus infection. We sought evidence from randomised clinical trials only. When conducted properly, such trials provide the best evidence. Two authors independently identified the trials and obtained the information from the trials to minimise error.

Antiviral therapy to prevent the recurrence of chronic hepatitis C infection in patients undergoing liver transplantation

The liver is an important organ of the body and has various functions including generation of energy from food, production of material necessary for congealing, processing and excretion of drugs and waste products in blood, and filtering out the harmful bacteria that enter the body through the gut. Hepatitis C virus can cause damage to the liver usually in an insidious manner (chronic hepatitis C virus infection). Sometimes, the liver damage can be so severe that the liver is not able to carry out the normal functions, which results in liver failure. Liver transplantation is effective in treating liver failure due to chronic hepatitis C infection. However, liver transplantation does not eradicate the virus and the virus can affect the donor liver graft. One of the proposed strategies to prevent the recurrence of chronic hepatitis C infection in these patients is to give drug treatment before the donor liver graft is affected by chronic hepatitis C infection. The effectiveness of these preventive treatments is not known. The review authors performed a detailed review of the medical literature to February 2013 to determine the benefits and harms of different preventive antiviral treatments for patients undergoing liver transplantation for chronic hepatitis C virus infection. The review authors sought evidence from randomised clinical trials only. When conducted properly, such trials provide the best evidence. Two review authors independently identified the trials and obtained the information from the trials to minimise error.

Simeprevir (Olysio) for chronic hepatitis C: Simeprevir (Olysio) for hepatitis C (genotype 1) for relapsed hepatitis C (genotype 1)

In 2014, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed the advantages and disadvantages of simeprevir in combination with peginterferon and ribavirin for treating chronic hepatitis C compared with conventional therapies.The following results apply to people who have chronic HCV infection who experienced a relapse after an initially successful treatment and who were not infected with HIV. One study compared treatment using simeprevir in combination with peginterferon alfa and ribavirin, with treatment using only peginterferon alfa and ribavirin.The results of these studies show that the following factors can influence the effectiveness of simeprevir:HCV genotype 1a and 1b: There are 6 different main types of the hepatitis C virus, which can be further divided into 60 subtypes called genotypes. Different medications are not equally effective against the various genotypes. Genotype 1a is more prevalent in the U.S., while genotype 1b is more common in Europe, for example.Q80K polymorphism: Simeprevir inhibits a protein that hepatitis C viruses need to reproduce. This protein may mutate, making simeprevir less effective. This mutation is referred to as the Q80K polymorphism.

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Other terms to know:
Cirrhosis, Viruses

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